99mTc-MIBI心肌灌注显像对冠心病诊断价值的系统分析

机检和手检查找99mTc-MIBI诊断冠心病的文献,应用QUADAS量表评价符合标准的文献质量,按心肌灌注显像类型分层,用Meta-disc软件对同类文献的敏感性、特异性、阳性似然比( LR)、阴性似然比(-LR)进行合并分析和异质性检验,对无异质性的文献绘制Asymmetric SROC曲线.共有29篇文献符合标准,当以所有患者为研究对象时,静息MPI、运动MPI、药物MPI合并 LR和合并-LR分别为2.209和0.224、4.334和0.141、5.508和0.195.使用较多的潘生丁药物负荷MPI的合并 LR、-LR分别为5.031、0.193.在无心梗病史患者的研究中,负荷MPI的合并 LR为6.176,合并-LR为0.199.由于本研究所纳文献在判读结果时未实施盲法,故研究结果间存在偏倚,而诊断结果间的变异则与疾病谱和选择标准密切相关,二者存在的可能性均较大,报告质量为中等.可以得出99mTc-MIBI负荷MPI尤其潘生丁MPI对冠心病有诊断价值.

The Diagnostic Value of 99mTc-MIBI Myocardial PerfusionImaging for Coronary Artery Disease: A Systematic Review

This review aims to evaluate the quality of studies assessing the value of 99mTc-MIBI myocardial perfusion imaging in the diagnosis of coronary artery disease. OVID (1956 to 2006), CBMdisc (1978 to 2006), CNKI (2005 to 2006) and VIP (2005 to 2006) for relevant studies in English and Chinese were searched and identified. Quality assessment of diagnostic accuracy studies (QUADAS) items were used. Studies were classified and Meta-disc software was used to analyze sensitivity, specificity, positive likelihood ratio and negative likelihood ratio for the pooled analysis and heterogeneity test, then Asymmetric SROC curves were drawn for those without heterogeneity. In 29 articles included, the results of the pooled analysis showed that, as for rest, exercise and drug myocardial perfusion imaging, the pooled LR + were 2.209, 4.334 and 5.508, the pooled LR- were 0.224, 0.141 and 0.195, and for dipyridamole myocardial perfusion imaging, the pooled LR+ and LR- were 5.031 and 0.193, respectively. Besides, for stress myocardial perfusion imaging among the patients without myocardial infarction history, the pooled LR+ and LR- were 6.176 and 0.199, respectively. The biases from the 29 studies were mainly due to diagnostic test results review bias; variations were probable and were correlated with the spectrum of disease and inclusion criteria; the quality of report was moderate. The conclusion is that 99mTc-MIBI stress MPI, especially dipyridamole MPI, is valuable for diagnosing coronary artery disease.